Provider Demographics
NPI:1720675242
Name:MITCHUM, MICHELLE (MSCJ/L, CHW, CPT, LC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MITCHUM
Suffix:
Gender:F
Credentials:MSCJ/L, CHW, CPT, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 COBURG LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-9014
Mailing Address - Country:US
Mailing Address - Phone:803-662-3377
Mailing Address - Fax:
Practice Address - Street 1:4631 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8180
Practice Address - Country:US
Practice Address - Phone:803-247-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy